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Sepsis in obstetrician

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https://www.readbyqxmd.com/read/30281901/group-a-streptococcus-puerperal-sepsis-an-emerging-obstetric-infection
#1
Brenna L Hughes
Group A Streptococcal (GAS) puerperal sepsis is considered, by most obstetricians, to be a rare disease. And it is. But it is a devastating one. The presentation is one that once seen, will literally never be forgotten. It is also one, that initially, can be so vague and nondescript as to only be obvious in the infamous "retrospectoscope". This article is protected by copyright. All rights reserved.
October 3, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29895996/maternal-and-early-perinatal-outcomes-of-triplet-pregnancy-study-of-82-triplets-from-a-single-perinatal-centre-in-south-india
#2
Priya Rajan, Srinivas Murki, Suseela Vavilala, Nirupama Surubhotla
Objectives: To study the recent trends in maternal and perinatal outcomes of triplet pregnancy from a perinatal centre in South India. Methods: All triplet pregnancies booked at Fernandez hospital, Hyderabad (a tertiary care perinatal centre in South India), or those referred between 2000 and 2014 were included in the study. The maternal, fetal and neonatal outcome and any interventions like cerclage, steroid administration were studied. Results: There were 82 triplet deliveries over the study period of 15 years (82 per 69,584 live births)...
June 2018: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/29518646/effect-of-delay-in-cord-clamping-45-versus-60-s-on-very-preterm-singleton-infants
#3
Arpitha Chiruvolu, Elise Elliott, Diana Rich, Genna Leal Stone, Huanying Qin, Robert W Inzer
BACKGROUND: In the range of timing suggested by American College of Obstetricians and Gynecologists 30 to 60 s, preterm infants may potentially derive more short and long-term benefits with delayed cord clamping (DCC) for at least 60 s. However, there are concerns with longer resuscitation delay in this vulnerable population. OBJECTIVE: To compare the clinical consequences of 45 versus 60 s delay in umbilical cord clamping in singleton infants born between 230/7 to 316/7 weeks gestation...
April 2018: Early Human Development
https://www.readbyqxmd.com/read/29324733/antibiotics-dispensed-to-privately-insured-pregnant-women-with-urinary-tract-infections-united-states-2014
#4
Elizabeth C Ailes, April D Summers, Emmy L Tran, Suzanne M Gilboa, Kathryn E Arnold, Dana Meaney-Delman, Jennita Reefhuis
Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1). Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2). Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance. Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4)...
January 12, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29130825/late-preterm-infants-early-term-infants-and-timing-of-elective-deliveries-current-status-in-a-korean-medical-center
#5
Hyun Sun Ko, Yu-Ri Jang, Hanggoo Yun, JeongHa Wie, Sae Kyung Choi, In Yang Park, Jong Chul Shin
OBJECTIVE: The aim of this study was to examine the current perinatal outcomes among infants born late-preterm and early-term compared to those born full-term and evaluate the optimal gestational age for delivery. METHODS: We performed a retrospective cohort study for births occurred at Seoul St. Mary's Hospital over the past 7 years. Statistical comparison was performed using χ2 test and multivariable logistic regression models. RESULTS: A total of 7580 women met the study criteria...
November 22, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29096709/strategies-for-preventing-group-b-streptococcal-infections-in-newborns-a-nation-wide-survey-of-italian-policies
#6
COMPARATIVE STUDY
Chryssoula Tzialla, Alberto Berardi, Claudio Farina, Pierangelo Clerici, Alessandro Borghesi, Elsa Viora, Paolo Scollo, Mauro Stronati
BACKGROUND: There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. METHODS: Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility...
November 2, 2017: Italian Journal of Pediatrics
https://www.readbyqxmd.com/read/29091782/ante-peri-and-postnatal-factors-associated-with-intraventricular-hemorrhage-in-very-premature-infants
#7
Martin Poryo, Judith Caroline Boeckh, Ludwig Gortner, Michael Zemlin, Perrine Duppré, Daniel Ebrahimi-Fakhari, Stefan Wagenpfeil, Matthias Heckmann, Eva Mildenberger, Anne Hilgendorff, Andreas W Flemmer, Georg Frey, Sascha Meyer
BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in preterm infants and is associated with neurological sequelae and mortality. Over the past few decades, the rate of IVH has decreased due to improved neonatal intensive care. However, up to 15-25% of very and extremely premature infants (<32 and <28weeks of pregnancy (WOP) respectively) still suffer from IVH. STUDY PURPOSE: The aim of this study was to perform an updated, multicenter analysis to identify ante-, peri, and postnatal factors other than gestational age/birth weight associated with IVH of any grade in a large cohort of very and extremely premature infants...
January 2018: Early Human Development
https://www.readbyqxmd.com/read/28785449/decompensated-heart-failure-in-pregnancy
#8
John Anthony, Karen Sliwa
Heart disease is a common cause of morbidity and mortality during pregnancy. Symptoms and signs of heart failure in a pregnant woman are an indication for urgent assessment to establish a diagnosis and appropriate management. This is best accomplished through a multidisciplinary approach in which both cardiologists and obstetricians need to participate in order to provide expert counselling and care in pursuit of safe motherhood. Congenital heart disease, although common, once corrected is an unusual source of complications, which are more likely to develop as a consequence of ventricular failure, pulmonary hypertension and aortic arch disease...
May 2016: Cardiac Failure Review
https://www.readbyqxmd.com/read/28742677/committee-opinion-no-712-intrapartum-management-of-intraamniotic-infection
#9
(no author information available yet)
Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Intraamniotic infection is a common condition noted among preterm and term parturients. However, most cases of intraamniotic infection detected and managed by obstetrician-gynecologists or other obstetric care providers will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28742671/committee-opinion-no-712-summary-intrapartum-management-of-intraamniotic-infection
#10
(no author information available yet)
Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Intraamniotic infection is a common condition noted among preterm and term parturients. However, most cases of intraamniotic infection detected and managed by obstetrician-gynecologists or other obstetric care providers will be noted among term patients in labor. Intraamniotic infection can be associated with acute neonatal morbidity, including neonatal pneumonia, meningitis, sepsis, and death...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28735702/quality-measures-in-high-risk-pregnancies-executive-summary-of-a-cooperative-workshop-of-the-society-for-maternal-fetal-medicine-national-institute-of-child-health-and-human-development-and-the-american-college-of-obstetricians-and-gynecologists
#11
Brian K Iriye, Kimberly D Gregory, George R Saade, William A Grobman, Haywood L Brown
Providers perceive current obstetric quality measures as imperfect and insufficient. Our organizations convened a "Quality Measures in High-Risk Pregnancies Workshop." The goals were to (1) review the current landscape regarding quality measures in obstetric conditions with increased risk for adverse maternal or fetal outcomes, (2) evaluate the available evidence for management of common obstetric conditions to identify those that may drive the highest impact on outcomes, quality, and value, (3) propose measures for high-risk obstetric conditions that reflect enhanced quality and efficiency, and (4) identify current research gaps, improve methods of data collection, and recommend means of change...
October 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28638306/effect-of-maternal-obesity-on-maternal-fetal-transfer-of-preoperative-cefazolin-at-cesarean-section
#12
Stephanie McKenney Groff, Wareef Fallatah, Samuel Yang, Jamie Murphy, Christopher Crutchfield, Mark Marzinke, Joanne Kurtzberg, Carlton K K Lee, Irina Burd, Azadeh Farzin
OBJECTIVES: American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis...
May 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/27816153/management-of-sepsis-and-septic-shock-for-the-obstetrician-gynecologist
#13
REVIEW
Lauren A Plante
The incidence of sepsis is increasing in the United States, both in the general adult population and among pregnant and postpartum women. Neither infection nor bacteremia are synonymous with sepsis: it is a dysregulated host response to a pathogen in which organ dysfunction is key. New clinical criteria have been released. Cornerstones of management are early suspicion and recognition, effective fluid resuscitation, and appropriate antimicrobial therapy.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27435163/metformin-in-women-with-type-2-diabetes-in-pregnancy-mity-a-multi-center-randomized-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Denice S Feig, Kellie Murphy, Elizabeth Asztalos, George Tomlinson, Johanna Sanchez, Bernard Zinman, Arne Ohlsson, Edmond A Ryan, I George Fantus, Anthony B Armson, Lorraine L Lipscombe, Jon F R Barrett
BACKGROUND: The incidence of type 2 diabetes in pregnancy is rising and rates of serious adverse maternal and fetal outcomes remain high. Metformin is a biguanide that is used as first-line treatment for non-pregnant patients with type 2 diabetes. We hypothesize that metformin use in pregnancy, as an adjunct to insulin, will decrease adverse outcomes by reducing maternal hyperglycemia, maternal insulin doses, maternal weight gain and gestational hypertension/pre-eclampsia. In addition, since metformin crosses the placenta, metformin treatment of the fetus may have a direct beneficial effect on neonatal outcomes...
July 19, 2016: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/27386763/intensive-care-and-pregnancy-epidemiology-and-general-principles-of-management-of-obstetrics-icu-patients-during-pregnancy
#15
REVIEW
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27156153/efficacy-and-safety-of-pelvic-packing-after-emergency-peripartum-hysterectomy-eph-in-postpartum-hemorrhage-pph-setting
#16
Omar Touhami, Sofiene Ben Marzouk, Mehdi Kehila, Laidi Bennasr, Aymen Fezai, Mohamed Badis Channoufi, Hayen El Magherbi
OBJECTIVES: To study the safety and effectiveness of pelvic packing in the control of post emergency peripartum hysterectomy (EPH) bleeding in a postpartum hemorrhage (PPH) setting. STUDY DESIGN: From 39 patients with a severe PPH leading to an EPH (January 2010-December 2013), we identified a group of 17 patients requiring a pelvic packing (packing group) and a second group of 22 patients not requiring a pelvic packing (non-packing group). For each group, transfusion requirements were recorded from time of PPH diagnosis to end of the surgical procedure (P1: Period 1) and from that point to the end management in the SICU (P2: Period 2)...
July 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/26905989/the-prevention-of-early-onset-neonatal-group-b-streptococcus-infection-new-zealand-consensus-guidelines-2014
#17
Brian Darlow, Norma Campbell, Nicloa Austin, Adrienne Chin, Celia Grigg, Craig Skidmore, Lesley Voss, Tony Walls, Michelle Wise, Anja Werno
AIMS: Group B streptococcal (GBS) disease is the leading cause of early-onset neonatal sepsis in New Zealand. Disease follows vertical transmission of GBS from the mother, which can largely be prevented by intravenous intrapartum antibiotics. A 2004 New Zealand guideline recommended using clinical risk factors to identify mothers who would qualify for intrapartum antibiotics. An expert multidisciplinary group met to reconsider these guidelines in the light of a two year survey of the incidence of early onset GBS neonatal sepsis...
November 20, 2015: New Zealand Medical Journal
https://www.readbyqxmd.com/read/26557575/appendicitis-in-postpartum-period-a-diagnostic-challenge
#18
Divya Wadhawan, Seema Singhal, Nivedtia Sarda, Renu Arora
Infections that occur in the postpartum period are assumed to be related to pregnancy or delivery; however other causes should also be considered. Appendicitis is one of the most common conditions requiring laparotomy during pregnancy, but very few cases of postpartum appendicitis have been reported. We report two such cases and the challenges faced by clinicians in diagnosis of immediate postpartum appendicitis. The first case was managed on lines of puerperal sepsis and the second one as enteric fever. Appendicular pathology was detected incidentally on laparotomy...
October 2015: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/26477627/-evaluation-of-the-interest-of-procalcitonin-in-the-diagnosis-of-chorioamnionitis-in-preterm-premature-rupture-of-membranes-an-observational-and-prospective-study
#19
V Ronzino-Dubost, N Sananès, T Lavaux, C Youssef, A Gaudineau, L Lecointre, B Langer
INTRODUCTION: Diagnosis of chorioamnionitis (CA) is difficult because all clinical and biological signs are rarely concordant. According to recent literature, PCT could act as a specific marker of bacterial infection. Our main objective was to assess whether PCT could improve our management of patients with preterm premature rupture of membranes (pPROM), allowing earlier and more specific diagnosis for CA. METHODS: Patients with pPROM from 24 and 34weeks of amenorrhea were included, from November 2013 to October 2014...
September 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/26444165/validation-of-the-content-of-the-prevention-protocol-for-early-sepsis-caused-by-streptococcus-agalactiaein-newborns
#20
Fabiana Alves da Silva, Cláudia Fernanda de Lacerda Vidal, Ednaldo Cavalcante de Araújo
OBJECTIVE: to validate the content of the prevention protocol for early sepsis caused by Streptococcus agalactiaein newborns. METHOD: a transversal, descriptive and methodological study, with a quantitative approach. The sample was composed of 15 judges, 8 obstetricians and 7 pediatricians. The validation occurred through the assessment of the content of the protocol by the judges that received the instrument for data collection - checklist - which contained 7 items that represent the requisites to be met by the protocol...
July 2015: Revista Latino-americana de Enfermagem
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